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smiling (particularly when afebrile), no urine output in 8 to 12 hours, stiff neck,
purple spots on the skin, difficulty breathing, difficult to awaken, fevers lasting
more than 3 to 4 days, or new symptoms that cause concern. Parent or guardian
should be able to access outpatient follow-up.
Suggested Readings and Key References
Pathophysiology and Thermometry
Allegaert K, Casteels K, Van Gorp I, et al. Tympanic, infrared skin, and temporal
artery scan thermometers compared with rectal measurement in children: a
real-life assessment. Curr Ther Res Clin Exp 2014;76:34–38.
Forrest AJ, Juliano ML, Conley SP, et al. Temporal artery and axillary
thermometry comparison with rectal thermometry in children presenting to the
ED. Am J Emerg Med 2017;35(12):1855–1858.
Kiekkas P, Aretha D, Almpani E, et al. Temporal artery thermometry in pediatric
patients: systematic review and meta-analysis. J Pediatr Nurs 2019;46:89–99.
Mogensen CB, Wittenhoff L, Fruerh⊘j G, et al. Forehead or ear temperature
measurement cannot replace rectal measurements, except for screening
purposes. BMC Pediatr 2018;18(1):15.
Evaluation/Decision
Balamuth F, Weiss SL, Fitzgerald JC, et al. Protocolized treatment is associated
with decreased organ dysfunction in pediatric severe sepsis. Pediatr Crit Care
Med 2016;17(9):817–822.
Kaplan SL, Barson WJ, Lin PL, et al. Serotype 19A is the most common serotype
causing invasive pneumococcal infections in children. Pediatrics
2010;125(3):429–436.
Kaplan SL, Barson WJ, Lin PL, et al. Early trends for invasive pneumococcal
infections in children after the introduction of the 13-valent pneumococcal
conjugate vaccine. Pediatr Infect Dis J 2013;32(3):203–207.
Kaplan SL, Schutze GE, Leake JA, et al. Multicenter surveillance of invasive
meningococcal infections in children. Pediatrics 2006;118(4):e979–e984.
Larru B, Gerber J. Cutaneous bacterial infections caused by Staphylococcus
aureus and Streptococcus pyogenes in infants and children. Pediatr Clin North